Case study: Undernutrition monitoring in care homes: Southern Health and Social Care Trust

Digital undernutrition service for care homes improves quality of care

A digital undernutrition service for care homes has improved the quality of care for residents through increased monitoring. Southern Health and Social Care Trust in Northern Ireland commissioned the service in March 2015 and it has resulted in more proactive treatment due to regular telephone reviews and the timely response of dietitians.

The service has been rolled out in 48 care homes in SHSCT, allowing for closer collaboration between the Trust and care homes through Inhealthcare’s secure web-based portal. Undernourished residents are closely monitored every one to two weeks by care home staff, who input the patient’s weight, appetite, and compliance to oral nutritional supplements (ONS) onto an online portal. If the patient is identified at risk of undernutrition using the Malnutrition Universal Screening Tool (MUST) or if any of the patient’s data falls outside of their pre-set personal parameters, a member of the dietetic team is alerted. The dietetic team will then contact the care home to provide dietary advice.

The challenges

• In 2014/15, oral nutrition support in the community/ domiciliary setting at Southern Health and Social Care
• Trust accounted for one-third of the adult Nutrition & Dietetic Service caseload.
• There was an increasing demand on the Nutrition & Dietetic Service as patients referred to the community service are more complex, often with multiple comorbidities.
• A significant resource was required for staff consultation time, travel time and travel costs.
• Dietetic intervention entails the use of oral nutrition supplements, which can be costly.

The solution

• Inhealthcare delivered an on-line system that regularly monitors adult patients who are identified as at risk of malnutrition and prescribed an oral nutritional supplement.
• Care pathways were developed with the aim being to provide a more responsive Nutrition & Dietetic Service, with a significant proportion of care provided remotely.
• Patients triggering alerts would receive Nutrition & Dietetic support, whilst those patients who remain stable would continue to be monitored by the care home staff.
• Patient information is made available to authorised health professionals through the patient record.

About the service

• Each patient is monitored for up to a maximum of 12 months.
• 11 care homes in the Newry & Mourne locality and 3 in the Dungannon area were selected to participate in the initial pilot.
• 11% of the patients in these care homes were under the care of the Nutrition and Dietetic service at commencement of the project.
• The pilot ran from 3rd March 2015 to 20th June 2016.
• Since the evaluation, the service has been rolled out to a further 34 care homes and has become part of the standard pathway within the Southern Health and Care Trust

Findings from the period of 3rd March 2015 to 20th June 2016 across 14 care home

• A 90% reduction in home visits – Before: 95% of patients reviewed face to face. After: 5% of patients reviewed face to face
• More timely reviews – Before: 6 week waiting time. After: 1-2 week waiting time
• Reduced intervention time – More than 1.75 hours saved per patient review. Before: 266 minutes. After: 161 minutes
• Quicker treatment for patients – The time spent on the pathway reduced – Before: 6-9+ months. After: 4 months
• Travel cost savings – Before: 2582 miles. After: 555 miles
• Savings on oral nutritional supplements – over £3000

Next steps

Evaluation of the year-long pilot at 14 care homes shows improved patient safety and outcomes, improved cost effectiveness and improved efficiency. Since the evaluation, the service has been rolled out to a further 34 care homes across Northern Ireland.